Chronic Comorbidities Contribute to the Burden and Costs of Persistent Asthma

Background. We aimed to study the prevalence of chronic comorbidities in asthma patients and the costs of health care use associated with asthma with comorbidities.Material and Methods. We analysed the prevalence of the four most common chronic diseases in asthma patients in 2008–2014 in Finland. Prevalence of coronary artery disease, diabetes and dyslipidaemia, hypertension, epilepsy, inflammatory bowel disease, rheumatic diseases, and severe psychiatric disease was studied by register of the Social Insurance Institution of Finland. The costs of health care services were collected from the registries maintained by the National Institute for Health and Welfare (THL).Results. Prevalence of asthma was 4.6% in 2014. Diabetes was among the four most common comorbidities in all the age groups. The other common comorbidities were hypertension (≥46 years; 12.9–37.6%), severe psychiatric disorders (age groups of 16–59 years; 1.4–3.5%), and ischaemic heart disease (≥60 years; 10–25%). In patients with both asthma and diabetes, the costs of hospitalization were approximately 169% compared with patients with asthma alone.Conclusions. Prevalence of asthma increases by tenfold when aging. The comorbidity diversity and rate are age-dependent. Prevalence of diabetes as comorbidity in asthma has increased. Costs of hospitalizations in asthma approximately double with chronic comorbidities.

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Impacts of mild COVID-19 on elevated use of primary and specialist health care services: A nationwide register study from Norway

PLoS ONE ◽

10.1371/journal.pone.0257926 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257926

Author(s):

Katrine Damgaard Skyrud ◽

Kjersti Helene Hernæs ◽

Kjetil Elias Telle ◽

Karin Magnusson

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Services ◽

Age Groups ◽

Relative Difference ◽

Health Care Use ◽

Positive Test ◽

Specialist Care ◽

Care Services ◽

Specialist Health Care

Aim To explore the temporal impact of mild COVID-19 on need for primary and specialist health care services. Methods In all adults (≥20 years) tested for SARS-CoV-2 in Norway March 1st 2020 to February 1st 2021 (N = 1 401 922), we contrasted the monthly all-cause health care use before and up to 6 months after the test (% relative difference), for patients with a positive test for SARS-CoV-2 (non-hospitalization, i.e. mild COVID-19) and patients with a negative test (no COVID-19). Results We found a substantial short-term elevation in primary care use in all age groups, with men generally having a higher relative increase (men 20–44 years: 522%, 95%CI = 509–535, 45–69 years: 439%, 95%CI = 426–452, ≥70 years: 199%, 95%CI = 180–218) than women (20–44 years: 342, 95%CI = 334–350, 45–69 years = 375, 95%CI = 365–385, ≥70 years: 156%, 95%CI = 141–171) at 1 month following positive test. At 2 months, this sex difference was less pronounced, with a (20–44 years: 21%, 95%CI = 13–29, 45–69 years = 38%, 95%CI = 30–46, ≥70 years: 15%, 95%CI = 3–28) increase in primary care use for men, and a (20–44 years: 30%, 95%CI = 24–36, 45–69 years = 57%, 95%CI = 50–64, ≥70 years: 14%, 95%CI = 4–24) increase for women. At 3 months after test, only women aged 45–70 years still had an increased primary care use (14%, 95%CI = 7–20). The increase was due to respiratory- and general/unspecified conditions. We observed no long-term (4–6 months) elevation in primary care use, and no elevation in specialist care use. Conclusion Mild COVID-19 gives an elevated need for primary care that vanishes 2–3 months after positive test. Middle-aged women had the most prolonged increased primary care use.

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Structure and Distribution of Health Care Costs across Age Groups of Patients with Multimorbidity in Lithuania

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052767 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2767

Author(s):

Laura Nedzinskienė ◽

Elena Jurevičienė ◽

Žydrūnė Visockienė ◽

Agnė Ulytė ◽

Roma Puronaitė ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Chronic Disease ◽

National Health Insurance ◽

Health Care Services ◽

Age Groups ◽

Age Group ◽

Resource Usage ◽

Care Services ◽

Care Costs

Background. Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of health care management decisions, which are often backed by limited, small-scale database analysis. The health care system in Lithuania is based on mandatory social health insurance and is covered by the National Health Insurance Fund. Based on a national Health Insurance database. The study aimed to explore the distribution, change, and interrelationships of health care costs across the age groups of patients with multimorbidity, suggesting different priorities at different age groups. Method. The study identified all adults with at least one chronic disease when any health care services were used over a three-year period between 2012 and 2014. Further data analysis excluded patients with single chronic conditions and further analysed patients with multimorbidity, accounting for increasing resource usage. The costs of primary, outpatient health care services; hospitalizations; reimbursed and paid out-of-pocket medications were analysed in eight age groups starting at 18 and up to 85 years and over. Results. The study identified a total of 428,430 adults in Lithuania with at least two different chronic diseases from the 32 chronic disease list. Out of the total expenditure within the group, 51.54% of the expenses were consumed for inpatient treatment, 30.90% for reimbursed medications. Across different age groups of patients with multimorbidity in Lithuania, 60% of the total cost is attributed to the age group of 65–84 years. The share in the total spending was the highest in the 75–84 years age group amounting to 29.53% of the overall expenditure, with an increase in hospitalization and a decrease in outpatient services. A decrease in health care expenses per capita in patients with multimorbidity after 85 years of age was observed. Conclusions. The highest proportion of health care expenses in patients with multimorbidity relates to hospitalization and reimbursed medications, increasing with age, but varies through different services. The study identifies the need to personalise the care of patients with multimorbidity in the primary-outpatient setting, aiming to reduce hospitalizations with proactive disease management.

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Do Patients Have Responsibilities in a Free-Market System? a Personal Perspective

Nursing Ethics ◽

10.1177/0969733007086024 ◽

2008 ◽

Vol 15 (2) ◽

pp. 263-273 ◽

Cited By ~ 13

Author(s):

Murat Civaner ◽

Berna Arda

Keyword(s):

Health Care ◽

Health Care Services ◽

Social Insurance ◽

Free Market ◽

Personal Perspective ◽

Current Debate ◽

Market System ◽

Care Services ◽

System A ◽

Free Market System

The current debate that surrounds the issue of patient rights and the transformation of health care, social insurance, and reimbursement systems has put the topic of patient responsibility on both the public and health care sectors' agenda. This climate of debate and transition provides an ideal time to rethink patient responsibilities, together with their underlying rationale, and to determine if they are properly represented when being called `patient' responsibilities. In this article we analyze the various types of patient responsibilities, identify the underlying motivations behind their creation, and conclude upon their sensibleness and merit. The range of patient responsibilities that have been proposed and implemented can be reclassified and placed into one of four groups, which are more accurate descriptors of the nature of these responsibilities. We suggest that, within the framework of a free-market system, where health care services are provided based on the ability to pay for them, none of these can properly be justified as a patient responsibility.

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DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA

Journal of Biosocial Science ◽

10.1017/s0021932017000530 ◽

2017 ◽

Vol 50 (6) ◽

pp. 749-769 ◽

Cited By ~ 8

Author(s):

Srinivas Goli ◽

Dipty Nawal ◽

Anu Rammohan ◽

T. V. Sekher ◽

Deepshikha Singh

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Care Services ◽

Socioeconomic Inequalities ◽

Maternal Health Care ◽

Health Care Use ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Care Services ◽

Maternal Health Care Services

SummaryThe gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010–11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of −0.1147, −0.1146, −0.2859 and −0.0638 for <3 antenatal care visits; CI of −0.1338, −0.0925, −0.1960 and −0.2531 for non-institutional delivery; and CI of −0.1153, −0.0370, −0.1817 and −0.0577 for no postnatal care within 2 days of delivery for Bangladesh, Ethiopia, Nepal and Zimbabwe, respectively. The marginal effects suggested that the strength of the association between the outcome and explanatory factors varied across the different countries. Decomposition estimates revealed that the key contributing factors for socioeconomic inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.

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Transition to Retirement and Use of Private Health Care

International Journal of Health Services ◽

10.1177/0020731416637828 ◽

2016 ◽

Vol 47 (2) ◽

pp. 312-332 ◽

Cited By ~ 2

Author(s):

Jenni Blomgren

Keyword(s):

Health Care ◽

Fixed Effects ◽

Health Care Services ◽

Health Care Use ◽

Median Income ◽

Private Health Care ◽

Universal System ◽

Private Care ◽

Care Services ◽

Demographic Covariates

Associations between retirement and changes in health care use have not been shown in a longitudinal setting. In the Finnish universal health care system, transition into retirement from employment entails loss of access to occupational health care that provides easily accessible primary health care services, which may cause changes in utilization of other health care sectors. The aim of this study was to find out whether transition into old-age retirement is associated with change in utilization of private health care. The panel data consist of a 30% random sample of the Finnish population aged 62–75 in 2006–2011. Register data on National Health Insurance compensation were linked to socio-demographic covariates. Fixed-effects logistic and Poisson regression models were used. Adjusted for changes in covariates, retirement from employment was associated especially with private general practitioner visits but also with specialist visits among both women and men. Interaction analyses showed that retirement was associated with an increase in private care use only among those with higher-than-median income. The results may indicate preferences for quick access to care, mistrust toward the universal system, and problems of the public system in delivering needed services.

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Understanding the Puzzle of Primary Health-care Use: Evidence from India

10.1101/2021.03.24.21254280 ◽

2021 ◽

Author(s):

Pramod Kumar Sur

Keyword(s):

Public Health ◽

Health Care ◽

Health Care Providers ◽

Health Care Services ◽

Health Care Use ◽

Public Health Care ◽

Private Health Care ◽

Care Providers ◽

Care Services ◽

Primary Health

In India, households' use of primary health-care services presents a puzzle. Even though most private health-care providers have no formal medical qualifications, a significant fraction of households use fee-charging private health-care services, which are not covered by insurance. Although the absence of public health-care providers could partially explain the high use of the private sector, this cannot be the only explanation. The private share of health-care use is even higher in markets where qualified doctors offer free care through public clinics; despite this free service, the majority of health-care visits are made to providers with no formal medical qualifications. This paper examines the reasons for the existence of this puzzle in India. Combining contemporary household-level data with archival records, I examine the aggressive family planning program implemented during the emergency rule in the 1970s and explore whether the coercion, disinformation, and carelessness involved in implementing the program could partly explain the puzzle. Exploiting the timing of the emergency rule, state-level variation in the number of sterilizations, and an instrumental variable approach, I show that the states heavily affected by the sterilization policy have a lower level of public health-care usage today. I demonstrate the mechanism for this practice by showing that the states heavily affected by forced sterilizations have a lower level of confidence in government hospitals and doctors and a higher level of confidence in private hospitals and doctors in providing good treatment.

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Patients’ Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China

Journal of Medical Internet Research ◽

10.2196/17221 ◽

2020 ◽

Vol 22 (6) ◽

pp. e17221 ◽

Cited By ~ 4

Author(s):

Peiyi Li ◽

Yunmei Luo ◽

Xuexin Yu ◽

Jin Wen ◽

Elizabeth Mason ◽

...

Keyword(s):

Health Care ◽

Health Care Services ◽

Age Groups ◽

Barriers And Facilitators ◽

Western China ◽

Cross Sectional ◽

Web Based ◽

Care Services ◽

Facilitators And Barriers ◽

Willingness To Use

Background As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users’ acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. Objective This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients’ willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. Methods We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients’ sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. Results Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). Conclusions We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.

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Pandemic trends in health care use: From the hospital bed to the general practitioner with COVID-19

10.1101/2021.07.09.21260249 ◽

2021 ◽

Author(s):

Fredrik Methi ◽

Kjersti Helene Hernaes ◽

Katrine Damgaard Skyrud ◽

Karin Magnusson

Keyword(s):

Primary Care ◽

Health Care ◽

Age Groups ◽

Health Care Use ◽

Specialist Care ◽

Care Services ◽

Primary Care Services ◽

Hospital Bed ◽

Bed Days ◽

The Mean

Aim: To explore whether the acute 30-day burden of COVID-19 on health care use has changed from the beginning to the end of the pandemic. Methods: In all Norwegians (N=122 699) who tested positive for SARS-CoV-2 in three pandemic waves (March 1st-July 31st 2020 (1st wave), August 1st-December 31st 2020 (2nd wave), and January 1st-May 31st 2021 (3rd wave)), we studied the age- and sex-specific share of patients (by age groups 1-19, 20-67, and 68 or more) who had: 1) Relied on self-care, 2) used primary care, and 3) used specialist care. Results: We find that a remarkably high and stable share (70-80%) of patients with COVID-19 exclusively had contact with primary care in the acute phase, both in the 1st, 2nd and 3rd wave. The mean number of primary care visits ranged between 2 and 4. We also show that the use of specialist care in the acute 30-day phase of COVID-19 has decreased, from 14% being hospitalized at least once during spring 2020, to 4% during spring 2021. The mean number of hospital bed-days decreased significantly for men from the 1st to the 2nd wave (from 13 days, 95% CI=11.5-14.5 to 10 days (9-11) for men aged ≥68 years, and from 11 days (10-12) to 9 days (8-10) for men aged 20-67 years), but not for women. Conclusion: COVID-19 places a continued high demand on the primary care services, and a decreasing demand on the specialist care services.

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Patients’ Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China (Preprint)

10.2196/preprints.17221 ◽

2019 ◽

Cited By ~ 1

Author(s):

Peiyi Li ◽

Yunmei Luo ◽

Xuexin Yu ◽

Jin Wen ◽

Elizabeth Mason ◽

...

Keyword(s):

Health Care ◽

Health Care Services ◽

Age Groups ◽

Barriers And Facilitators ◽

Western China ◽

Cross Sectional ◽

Web Based ◽

Care Services ◽

Facilitators And Barriers ◽

Willingness To Use

BACKGROUND As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users’ acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. OBJECTIVE This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients’ willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. METHODS We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients’ sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. RESULTS Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). CONCLUSIONS We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.

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Health status of female Moldovan migrants to Italy by health literacy level and age group: a descriptive study

BMC Public Health ◽

10.1186/s12889-020-09582-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Francesca Alice Vianello ◽

Federica Zaccagnini ◽

Carlo Pinato ◽

Pietro Maculan ◽

Alessandra Buja

Keyword(s):

Health Care ◽

Health Literacy ◽

Health Care Services ◽

Age Groups ◽

Migrant Women ◽

Care Services ◽

Health Literacy Level ◽

Care Workers ◽

Access To Health ◽

Literacy Level

Abstract Background Migration flows from Eastern Europe to Italy have been large and continue to grow. The purpose of this study was to examine the health status of a population of Moldovan migrant women, and their access to health care services in northern Italy, by age group and health literacy level. Methods We administered an ad-hoc questionnaire to adult Moldovan women. A bivariate analysis was conducted to test the association between health literacy and age groups with other variables (lifestyles, symptoms and diseases, access to health services). A stepwise logistic regression analysis was run to test the association between access to primary care and health literacy. Moreover, the study compare Moldovan women data with a sample of Italian women of the same age range living in North-Eastern region. Results Our sample included 170 Moldovan women (aged 46.5 ± 12.3) in five occupational categories: home care workers (28.2%); cleaners (27.1%); health care workers (5.9%); other occupations (28.8%); and unemployed (10%). Active smokers were twice as prevalent among the women with a low health literacy. Health literacy level also determined access to primary healthcare services. For all age groups, the Moldovan sample reported a higher prevalence of allergies, lumbar disorders and depression than the Italian controls. Conclusions The reported prevalence of some diseases was higher among Moldovan migrant women than among Italian resident women. Health literacy was associated with the migrant women’s lifestyle and the use of primary health care services, as previously seen for the autochthonous population.

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